Sound produced by “burping” and shaping words in the mouth. Difficult to master! Speech is monotone 1. Tongue press to inject air into esophagus 2. Air enters esophagus 3. Air releases from esophagus to produce sound-use abdominal muscles to burp 4. Sound shaped into speech 5. Location of tissue vibration for sound

Tracheoesophageal Puncture (TEP)

AKA: Tracheoesophageal fistula. Used if esophageal speech ineffective 1. Small hole is made rear of stoma leading to esophagus (between trachea & esophagus) 2. A prosthesis is fitted & inserted into opening 3. To speak, pt has to close stoma w/ finger & force air through prosthesis into the esophagus & out the mouth 4. Lip & tongue movement, not prothesis itself produces speech

Tracheotomy

Surgical incision into trachea for purpose of establishing an airway (tracheostomy). Temporary or permanent. Emergency or scheduled.

-Ask pt about passing the time, visitors, & trips outside house -Observe if pt communicates directly or if family member speaks for the pt -Observe pt & family member interactions -Determine what method of communication pt has selected & observe pt’s skill w/ it -Observe if pt is dressed in pj’s or street clothes